Tavenner unloads more answers on Medicaid expansion, IPAB

CMS Administrator and Secretary of the Medicare Trustees Marilyn Tavenner

Marilyn Tavenner, the interim administrator of the Centers for Medicare & Medicaid Services who is vying to remove the “interim” label, met lawmaker questions head-on following her April 9 confirmation hearing. Last week, officials released 125 pages containing her answers to further inquiries from members of the Senate Finance Committee.

Tavenner answered submitted questions about bundled payments, Medicaid expansion the Independent Payment Advisory Board and more following the hearing.

Many inquiries focused on the Affordable Care Act, including the Medicaid expansion. Sen. Jay Rockefeller (D-WV) asked about managed care for Medicaid beneficiaries, specifically what steps federal regulators were taking to “monitor quality, plan performance and patient experience” under new Medicaid models.

Tavenner wrote, “States have the flexibility under the statute to adopt managed care without a waiver, but some have pursued the use of managed care to deliver benefits through 1,115 demonstrations. CMS has worked with states to ensure the appropriate use of this delivery system, to promote quality and improve health outcomes.

“Demonstrations include ongoing monitoring plans to assure contract compliance, network and benefit adequacy and the quality of care provided and, particularly with respect to long-term services and supports, we have worked with states to create or expand ombudsman offices to help beneficiaries with transition.”

Senate Finance Committee chairman Max Baucus (D- MT) asked about accountable care organizations, noting, “CMS is still testing many of these models and it may be too early to determine their effectiveness” and asking about the role of physicians and fee-for-service models, especially in rural areas.

Tavenner noted that in some accountable care organization models, rural or physician-owned groups “receive upfront and monthly payments, which they can use to make important investments in their care coordination infrastructure.”

“We think episode-based payment has great potential to transform the delivery system. We are confident that these initiatives will enable the Congress to build a reformed physician payment system,” she wrote.

Sen. John Cornyn (R-Texas) asked about the Independent Payment Advisory Board, which has been a thorn in the sides of some lawmakers. Cornyn suggested it would lead to provider payments being so low that care will be rationed.